Active NPI
Colleen Marie Becket-Davenport
- Clinical Psychologist
- Oakland, CA
National Provider Identifier
1124377577
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY30368
- Practice address
- 1015 Aileen St
D
Oakland, CA 94608-2710 - Phone
- (707) 373-8811
- NPI assigned
- Aug 30, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY30368 | CA | Primary |
Addresses
Primary practice location
1015 Aileen St
D
Oakland, CA 94608-2710
Mailing address
795 Willow Rd
Menlo Park, CA 94025-2539
Phone (415) 236-2499
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY30368 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346284800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1561680000000",
"number": "1124377577",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "795 WILLOW RD",
"city": "MENLO PARK",
"state": "CA",
"postal_code": "940252539",
"telephone_number": "415-236-2499"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1015 AILEEN ST",
"address_2": "D",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946082710",
"telephone_number": "707-373-8811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BECKET-DAVENPORT",
"first_name": "COLLEEN",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-08-30",
"last_updated": "2019-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY30368",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.